Dr. Shulman said. “The government came to us and
asked us to help build a national hospital,” he said,
which turned out to be the Hôpital Universitaire de
Mirebalais that opened in April 2013. As in Rwanda,
Dana-Farber clinicians and staff assist with treatment,
train local physicians and nurses, and lay the groundwork for cancer care.† Treatment is, again, provided
free of charge.
As director of the UPenn’s Center for Global Cancer
Medicine, Dr. Shulman now leads the cancer care program in Botswana, a nation in which UPenn has had
a presence in other medical areas for 15 years. Dr.
Shulman’s expertise in medical oncology has allowed
them to expand their former human immunodeficiency
virus-focused treatment to include cancer care, and his
ties with PIH have opened their sites to UPenn trainees, students, and staff of all levels.
Identifying gaps, increasing value
Dr. Shulman was elected to head the Commission at a
time of considerable change in U.S. health care. Aside
from broader political uncertainty regarding health
insurance coverage, “The challenge that is facing us as
a nation is the intersection between quality and cost,”
Dr. Shulman said, and attempting to increase the former
without increasing the latter. His goals as Chair, and the
direction of the CoC’s attention, will in part be dedicated
to balancing the two sides of the health care equation
to provide the greatest value to patients.
Part of understanding where the CoC should be
heading involves looking into cancer care in the U.S.
and seeing the areas where it is lacking—where quality could be better—and developing interventions to
improve care and increase value. “There are areas where
we aren’t doing as well as we could,” Dr. Shulman said.
“Rectal cancer, for instance, is one of those areas where
we can see that treatment is more consistently of higher
quality in Europe than in the U.S., which is an unnerving finding.” To increase the quality of cancer care in the
U.S., the CoC plans to launch the National Accreditation
Program for Rectal Cancer (NAPRC) this year. As the
ACS National Accreditation Program for Breast Centers
does for breast cancer, the NAPRC will accredit cancer
centers that hold to high standards of rectal cancer treatment. As Chair, Dr. Shulman wants to identify other
areas in which cancer care is of variable quality.
Another area where Dr. Shulman believes the CoC
can play a more direct role in addressing quality
and cost concerns is with oncology medical home
accreditation. An oncology medical home is a primary oncologist or oncologic practice that acts as
the focal point for coordinating the patient’s comprehensive cancer care. Having a dedicated coordinator
for patients’ cancer treatments and the processes in
place to better care for patients can have a positive
effect on quality, efficiency, and cost of care.‡ “This
Commission hasn’t been very involved in that space
previously, but we did a pilot test of Oncology Medical Home accreditation visits, which is in the domain
of trying to improve quality and cost effectiveness
of care,” Dr. Shulman said. The CoC has performed
approximately 10 pilot surveys and is now determining whether to pursue the program on a national scale.
The CoC also has been engaged in ongoing talks
with national payors and insurers, such as Blue Cross
Blue Shield Association, about what they can learn from
the organization about measuring quality and how it
relates to cost. Dr. Shulman believes that the CoC, a
national leader in driving quality of cancer care, needs
to stay relevant in the quality and cost space. “We have
over 1,500 accredited hospitals, which covers about 70
percent of cancer patients in the U.S. There’s no other
organization that’s attached in such a direct way to the
performance of so much of cancer care in the country,”
Dr. Shulman said. “I think we’re in a special position
where we can both influence the direction of cancer
care and try to help solve some of the overarching problems in U.S. health care, as well.” ♦
†Dana-Farber Cancer Institute. Center for Global Cancer Medicine: Haiti
Partnership. Available at: www.dana-farber.org/Adult-Care/Treatment-and-Support/Treatment-Centers-and-Clinical-Services/Center-for-Global-Cancer-Medicine.aspx#Haiti_Partnership. Accessed May 5, 2017.
‡Community Oncology Alliance. Oncology Medical Home Initiative:
Overvie w. Available at: www.medicalhomeoncology.org/UserFiles/COA_
Oncology_Medical_Home_Initiative_9-21-12.pdf. Accessed May 18, 2017.
Part of understanding where the CoC should be heading
involves looking into cancer care in the U.S. and seeing the
areas where it is lacking—where quality could be better—and
developing interventions to improve care and increase value.